When I Needed Emergency Contraception, I Was Glad I Was in the Middle East

We were barely in our hotel room in Damascus, Syria a half hour before our afternoon delight came to a jolting halt. Khair, my husband, who is Syrian and always calm in emergency situations, muttered an understated “uh oh.” I knew from his panicked expression it had to be bad before I even looked down at the ripped condom.

I spent the summer of 2006 studying Arabic and living with Khair’s family in Damascus. He stayed behind in Alabama, where we were both in grad school. Khair planned to join me at his family’s house for the tail end of my trip, but as the months apart grew long, we decided to spring for a hotel room for our first night back together. Even though we were far from wanting children, still living on student loans and not having begun any of the grand plans we had for our lives, I wasn’t on birth control at the time due to a recent tonsillectomy. Leaving our fate up to a thin, stretchy membrane always made me nervous, and now as I stared in disbelief at the latex carnage, it began to sink in that one of my worst fears had actually happened. I ran to the bathroom in tears. Khair paced in circles, biting a thumbnail and trying to think of a solution. Finally he decided to call the only person who would know what to do in a situation like this: his mom.

As Khair relayed the situation to his mother, Faten, in frenzied Arabic, and I sat mortified, my ear caught snippets of recognizable phrases: “Mama… Plan B…progestin.” I thought he was crazy to think she would find emergency contraceptive in Syria, especially in such a hurry. Plan B One-Step, also known generically as the “morning-after pill,” had only recently become available without a prescription in the United States and remained mired in controversy. The director of the FDA’s Office of Women’s Health had resigned a few months earlier to protest the political heel-dragging that kept the drug’s application for over-the-counter approval in limbo for two years, despite having been deemed safe by the FDA.

But even after its approval, when the morning-after pill should have been readily available in any drugstore across the U.S., it wasn’t. Local news stations where we lived in southern Alabama had been running story after story about pharmacies refusing to sell it on religious and moral grounds. In response, women’s health advocates provided online lists of pharmacies in the area where the morning-after pill was and was not available. They advised sexually active women to try to buy one to have on-hand because it could be difficult to find in an emergency, precisely when it would be needed most (Plan B is most effective within 72 hours of intercourse).

Now, in Damascus, I was kicking myself for not taking their advice and assumed that if it was difficult to find the morning-after pill in the Bible belt, it would be even harder in Syria, a deeply religious, predominantly Muslim country. Khair hung up the phone with his mother, coaxed me off the bidet, and wrapped me in a waffled hotel bathrobe.

“She’s heard of the morning-after pill,” he said with measured optimism. “That’s a good sign.”

“I don’t know,” I responded, not to be comforted that easily. I could only think of how hard it was to get the pill back home.

But what I didn’t know then is that women’s reproductive rights are not the hot-button political issue in Syria that they are in the United States. Oral birth control became available over-the-counter decades ago there, pretty much as soon as it reached international market availability. The same was true for emergency contraceptive. Once the morning-after pill was available and deemed safe, it was put on the market in Syria without any political interference or talking heads debating its morality.

There’s no doubt that attitudes on birth control are influenced by the Muslim belief that it takes four months for a fetus to receive its soul or “humanness,” and that it is acceptable to terminate a pregnancy up to that point, especially when the life of the mother is in danger. But there’s also more to it than that…more than the question of when life begins. Though traditional gender roles are still potent in Syria, the idea that a stranger, particularly a pharmacist or a politician, should decide for a woman what medication and contraceptives she has access to, is foreign.

Had I known all of this, I wouldn’t have been as surprised when the phone rang only an hour or two later, jolting us awake on the hotel bed where we had collapsed from emotional exhaustion, dinner plans long forgotten. It was Faten. She was calling to say she had the morning-after pill for me. The pharmacist had told Faten I should take it with food, so we invited her to meet us for ice cream.

I marveled that she had found it and thought it would just be a matter of time until the morning-after pill debate would blow over in the U.S. I could not have imagined that six years later in 2012, 14 states would still have “conscience clauses,” enabling them to refuse to dispense emergency contraceptives (and birth control) on the basis of their religious beliefs (In September, two pharmacists in Illinois won a seven-year lawsuit upholding their right to refuse to dispense emergency contraceptives, despite an Illinois state law requiring pharmacies to dispense FDA-approved contraceptives). Back in 2006, I also could not have imagined that instead of women’s reproductive rights progressing ever forward, they would come under greater threat and that the news would be dominated by politicians talking about “legitimate rape” and rights of employers to decide if their female employees should have insurance coverage for birth control.

A few minutes after Faten called, the three of us were seated around a small table in heart-shaped metal chairs, the type you see in old-time ice cream parlors across the U.S. Khair’s mother gingerly took the flat box from her purse and pushed it across the table with the slightest hint of a mischievous smile. As I reached for it and met Faten’s gaze, I was struck by the irony of the situation. Here I was in the heart of the Middle East and my Muslim mother-in-law, who at the time covered her hair with the veil and made no secret of her desire for a grandchild (three years of marriage with no baby to show is still nearly unheard of in Syria), had gotten a pill for me that would delay even further her desperate wish to become a grandmother. A pill that in the United States was still deeply controversial and difficult to come by.

I teased her, asking how I could trust she wasn’t giving me a sugar pill. She laughed, perhaps wishing she had thought of that, but then became serious and clucked her tongue. “No, Vic,” she said, shaking her head. Ultimately, as a woman, a Muslim Arab woman, she understood what many U.S. lawmakers still don’t: that reproduction is a woman’s individual choice.

I pushed the pill through the foil wrapping and swallowed it. Then I chased it down with a spoonful of hot fudge sundae, thankful that if it had to happen, at least it had happened in Syria.